Establishing the proper length to restore teeth is a critical factor in the success of a case and the happiness of the patient. The technique described in this article, will help guide the entire case and create the ideal overbite and overjet. According to a study conducted by the AACD it was discovered that “virtually all Americans (99.7%) believe a smile is an important social asset”. One can surmise then, that a person’s teeth is one of the first things to be noticed when meeting someone. When restoring a person’s smile, usually the goal is to create an ideal situation that mimics a youthful appearance. One of the critical issues in deciding how to proceed is determining if the vertical dimension needs to be opened and if it is determined that indeed it needs to be opened the next question is by how much?
Since we have already determined that the smile is one of the most important features a person has, being able to see the teeth when a person is at rest or in repose is important in achieving a youthful appearance. If a patient is in repose and there is no teeth exposure they appear as though they have no teeth. This can be a deterring factor to a youthful appearance and an indication that the vertical dimension needs to be opened. (see p1)
Other indicators that a patient may have lost vertical dimension is if the corners of the mouth are turned down as if there is a reverse smile. From a profile view is the chin more forward? Do the masseter muscles appear to be over developed? Once this has been evaluated and it can be determined that a loss of vertical dimension is evident a complete wax rendering can begin to determine exactly what needs to occur to restore the patient.
In order to begin a wax up the first thing that must be determined is what is the ideal vertical opening? To do this one must determine how long the centrals need to be to have teeth exposure in the repose position. Once this is determined the rest of the treatment will be designed based on this length. Ideally there should be at least 1 mm exposure past the upper lip. To get this measurement the following steps should be used:
- Use white rope wax approximately the size that will cover the anterior teeth
- Flatten the wax , and after drying the surface of the teeth, place the flat wax over the upper anterior teeth and flatten it so that it will only add length and not add any labial volume. (see p2)
- Ask the patient to relax so that they are in a repose position and observe the amount of wax exposure if its too much, use your finger to push the wax upwards slowly to shorten the exposure. (see p3)
- If the amount of incisal length is too long, out of the parameters to be considered a reasonable length, add volume labially by using another flat wax on top of the previous wax. This will push the lips a little outwards reducing the need to increase too much length. This is also a good way to push out the upper lip, and create lip volume without surgery.
- Once the length and fullness has been established, measure the length using calipers for length and overjet. Placing the open caliper against the tooth we can see how much tooth lengthening will be necessary to achieve the desired results. (see p4 and p5)
Once that measurement is given to the lab, we wax one central to the desired length of the tooth and we wax one lower anterior tooth approximately 8mm to 9 mm. We then measure from the incisal edge towards the gingival a 2 mm distance and we make a horizontal line on the lower waxed tooth. On the articulator, we will open the bite (vertical dimension) as we place the selected waxed up upper tooth to the line on the lower tooth. This will give us the ideal opening. Generally, it is recommended to have a 2 mm overbite and 2 mm over jet. At times this ideal may need to be altered based on other considerations.
Using this technique, the case always starts with aesthetic considerations and then aesthetics are coupled with occlusion and functional designs that support the newly created length. Achieving optimal results in everything from veneer cases to full mouth rehabilitation starts with a great design. With a smile holding such an important place in society, designing cases that take in to consideration the importance of the end result is certainly what keeps Opus One focused on finding new ways to create excellent new smiles. (see p6)
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